Lynne Geweke, MD, director of the Headache Clinic at University of Iowa Hospitals and Clinics, talks about headaches, treatment and research.

Are there different types of headaches?

In a headache clinic setting, the most common kinds of headaches we see are migraines. Those are the sick headaches. Those are the ones that make people nauseated, they’re very sensitive to light, they really can’t function; it’s a pounding headache and it may be on just half of the head.

The most common headache type overall is what we call a tension-type headache. That’s the kind of everyday headache that a lot of people have; you take two aspirin, it goes away. There are, of course, some rarer types of headaches that I won’t go into now, and everybody worries about dangerous headaches: brain tumors and aneurisms and things like that, but fortunately those last ones are pretty rare. In a headache clinic, I mostly deal with migraines.

What symptoms define a headache as a migraine headache?

I think the pounding is a big one; nausea is probably the biggest one. That pretty much pins it as a migraine, and the light and noise sensitivity, and smell sensitivity; people who have migraines really are in bed, in a dark room with a cold cloth across their forehead and a bucket at the side of bed; they’re just out sick.

Recent research suggests a connection between sinus headaches and migraines. Can you tell us more about that?

Actually, the connection is that sinus headaches are significantly over-diagnosed and migraine headaches are way under-diagnosed. A recent survey showed that of 100 people who thought they had sinus headaches, actually 75 percent of them had migraine headaches instead, and they did not have sinus headaches. People make this confusion because migraine headaches can be felt in the front of the head in what people think of as the sinus area; people can have a little stuffiness along with a migraine headache; but sinus headaches, you should have really bad sinuses to go along with this. If you keep having these headaches over and over with a little stuffiness and the pain in the front of the head, you should go get this looked at. You may be treating them wrong.

How is migraine headache treated?

Some people with mild migraines can treat these over the counter with some medications, but from a doctor’s standpoint, there are really two ways to treat a headache with medications. One is to take something when you have a headache to try to get rid of it – that’s what we call an abortive treatment, and we have a lot of really good new medications for this that have come out in the last 10 or 15 years. When migraine headaches are frequent, so frequent that they really become disabling, we will often give people preventive medicines, and these are things that are meant to be taken every day to try to prevent the headache.

Can people take too many over the counter medications and actually make their headaches worse?

Absolutely, this is a big problem in headache clinics. If you have frequent headaches, you should not be taking anything that’s a pain medication more frequently then about two days per week. You can get into what we call a rebound headache, it’s like a withdrawal headache from the medicine, and even Tylenol, aspirin, and all the over the counter stuff can do this.

So it’s very common that I see people who have headaches everyday and they’re taking 6, 8, 10, 12 tablets for their headaches everyday. They can also get into this with regular prescription medications, all the way from the regular migraine medicines up to narcotics. So anytime people are taking pain medicines about more than twice a week, the answer is not to take more medicines to try to make it better, the answer it try to get off those medicines and get a good preventive instead.

When should a person suffering from headaches seek medical treatment?

I think the answer to that really is the disability question. If you’re down, missing work, if you can’t function at home, if the headaches are really interfering with your quality of life, you should go see a physician about this.

Are there instances when a headache may be the warning sign of something more significant and should be treated as an emergency?

Anytime someone has a new and different headache that just strikes out of the blue; I often say the first or worst headache—never had a headache like this before and it’s bad, or it’s just so different from anything that’s happened and it’s much worse than previous headaches. Also, kind of a new headache that just keeps getting worse, and keeps getting worse, and keeps getting worse. Or if it’s associated with anything out of the ordinary, people with migraines can be down and very sensitive to light, but everything else should work in their bodies. So if there’s anything else about the headache that makes you nervous, go see a doctor.

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